Why you pay more each year for health insurance, yet remain in poor health

It can be scary to feel sick, not know why it's happening, and being offered a few solutions.

It’s frustrating to be told you must take a drug for the rest of your life, especially when there are side effects.

It’s overwhelming to be told you need a pricey drug or expensive hospital procedure, but you don’t know if it’s the right thing to do.

We assume our doctors and insurance companies have our best interests at heart, but do they?

How does your insurance keep you in poor health while you pay more?

1. Your insurance company happily accepts rebates on the drugs you take while you’re meeting your deductible. You’re paying 100% out of your pocket and they’re getting paid while you do so. Can you see why they want you to take drugs?
2. Your annual deductible continues to balloon upward, but “the hurt” you feel in your wallet is actually a profitable situation for your insurance company. They don’t have to pay for your care while you meet your deductible, so the larger it is the better it is for them financially.
3. They encourage expensive, invasive surgery despite less expensive, safer options being available. See below for the specifics.
4. Insurance continues to pay for expensive, invasive procedures, even when a placebo works as well. The proof is below.
5. They “push” expensive, less effective drugs, even when it’s well known that inexpensive generic works better. Continue reading for the proof.

I review the facts behind each point below.

1.Your insurance company receives rebates for all the drugs you take, even while you’re meeting your deductible.

According to a report by the president and CEO of the Pharmaceutical Research & Manufacturers of America (PhRMA):

“A patient with diabetes named Scott is covered by a high-deductible health plan and takes an insulin product that has a list price of $400. His insurer negotiates a 65% rebate on the price of that drug.” “Problem is, Scott hasn’t reached his deductible, so he pays the full price. Meanwhile, the pharma company that makes the drug gets $88 and the insurer gets a $239 rebate.”

2.Your annual deductible continues to balloon upward, but “the hurt” you feel in your wallet is a profitable situation for your insurance company.

Of course, if your insurance company can put off paying anything towards your care, that’s a benefit for them.

According to the author of An American Sickness, an insurer can compensate for any excess expenditures they encounter in various ways — by raising premiums, co-payments, or deductibles.

Insurance companies are going to ensure they’re profitable. They must be to keep their shareholders happy and afford massive salaries.

3.Your insurance company encourages expensive, invasive procedures despite less expensive, safer options being readily available.

The proof is in a New England Journal of Medicine study from 2007. Two thousand patients were tracked for 5 years. The goal was to determine if there was any difference in health outcomes between patients taking medications vs. receiving a stent operation, which costs about $40,000. (A stent is a wire mesh placed in an artery to keep it open.) [Reference: New England Journal of Medicine. 2007 Apr 12;356(15):1503-16. Epub 2007 Mar 26. Optimal medical therapy with or without PCI for stable coronary disease.

In other words, did the substantially less invasive and less expensive generic drugs perform as well as the stent, as it related to the incidence of heart attacks or death? The answer found was “yes”. The drugs performed just as well as the stent.

The Courage study, as it was named, found no difference in patient outcome, but a huge difference in cost.

It was estimated that our country could save $5 billion per year if doctors would follow the guidelines laid out by the study.

The recommendations, however, were not headed and we did not save $5 billion dollars. We are still performing about a million stent procedures per year in the U.S.

Why?

As one author aptly stated: studies that find “an already popular and lucrative treatment unnecessary, but not harmful, have rarely altered medical practice.”

Stents are most definitely lucrative but they also are potentially harmful. One in 50 will suffer a serious complication or die, as a result of a stent procedure. [Reference: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1108733]

I don’t want to overwhelm you with data, but here are some further links you can check out on this topic. It’s not pretty; I warn you.

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1108733]

http://www.onlinejacc.org/content/early/2016/12/20/j.jacc.2016.12.005]

https://www.theatlantic.com/health/archive/2017/02/when-evidence-says-no-but-doctors-say-yes/517368/

4.Your health insurance company continues to pay for expensive, invasive procedures, even when a placebo works as well.

A 2018 study evaluated 200 patients that were given a drug protocol along with a placebo “operation” or an actual stent. The goal was to determine if a patient’s ability to exercise without developing chest pain was different from drugs vs. a stent.

There was no difference in chest pain between the two groups – the placebo or “non-operation” worked as well as the actual stent implantation.

5.They “push” expensive, less effective drugs, even when it’s well known that inexpensive generics work better.

More than 100 million Americans have high blood pressure and many take a daily medication, earning pharmaceutical companies billions.

A generic blood pressure pill was discovered, in 2002, to work better than a costlier drug, Norvasc.

Did drug sales of Norvasc decline with this discovery? No. Sales continued to climb from $3.8 billion in 2002 to $4.9 billion in 2006.

It’s one thing to be in the category of “no harm” or “no clear added benefit”, but to continue to opt for a more expensive medication that was proven to be an inferior product, should get your attention.

Do you agree? I’d like to hear from you.

Some of this data is a bit hard to swallow. I understand. But it’s the truth. If you liked this blog please share it with friends and family.

It’s time to put the “health” back into healthcare

Big Pharma and health insurance are each trillion-dollar goliaths,  but we don’t need to suffer at their hands.

The solution? Get and stay healthy.

How? 

By addressing the reason your body is giving you symptoms. Not suppressing symptoms with dangerous and expensive drugs, but really fixing the problem at its root.

This is your solution to high priced drugs and the financial motivation of health insurance companies to keep you unwell.

Root Cause Medical Clinic specializes in, and achieves, the reversal of many chronic health conditions: from fatigue to digestive issues, from heart disease to type 2 diabetes, and from pain to overweight – We know how to get the job done. 

We don’t just hand you a pill. You are an active participant in regaining your health, and we’re here beside you, working together as a team. Because you can’t do it alone.